The Flows of Modern Birthing

​​You have probably heard of ‘The Cascade of Intervention’.  It is the idea that once an intervention occurs, the rest shall follow.  This is considered a ‘Slippery Slope’.  It is, however, more nuanced than a cascade and there is more than one slope.  If we think of physiological birth as a flowing river, there are many possible forks. If we are unprepared (going with the flow) we are at the mercy of the strongest current, which will divert us into one of many possible forks in the river. If we are prepared (with our map), we can control which fork we will take. We can determine which will be our safest route because we understand the flows.

The Flows of Modern Birthing (above) shows the main possibilities we can prepare for. Each of these possibilities has several decision points, meaning consent is required (see The Trouble with Consent).

Sometimes a decision is medically indicated, sometimes other external pressures put us at the decision-point, sometimes it is our internal dialogue that takes us there. With a Birth Map, this can be an autonomous experience. We can avoid a traumatic, dramatic, stressful or crushing experience, which can result from going with the flow.  Many women talk positively of their births, no matter which path, because they were prepared, felt respected and included and understood what was happening.

Let’s consider induction

Induction interventions include the ‘stretch and sweep’, hormone gel inserts, artificial rupture of membranes and synthetic oxytocin. There are many more inductions than are necessary, and this often is enough to cause a cascade of consent.  Knowing when to accept intervention is important.

Sometimes an induction ‘kick starts’ labour, and a women labours and births with no further intervention. However, once a labour is induced, it will be managed. This may involve monitoring and observation, restrictions on the mother and interruptions that actually inhibit effective labour. The mother may now have a time frame and limit she ‘must’ labour to. If labour is not following this ‘schedule’, it may become augmented. This usually means synthetic oxytocin (which restricts movement and increases intensity). Often this is accompanied by an epidural.  This is why it is often referred to as a cascade.  It is very easy to find yourself ‘going with the flow’.

Often an augmented labour leads to an augmented birth. This is also called ‘assisted delivery’.  This might be directed pushing, vacuum assistance, or forceps. The mother will be on her back, and may have her legs held by people or stirrups. This birth is usually set up for the benefit of attendants, not the mother.  This is also where the greatest risk of severe perineal tear occurs. (See Protecting your Perineum).

A managed third stage is often routine, and many women do not realise they have options or even what is meant by ‘third stage’. A spontaneous and unaugmented labour and birth can be interrupted by a managed third stage. This often leaves a mother feeling ‘dealt with’, rather than involved with the birth (increasing the risk of experiencing emotional trauma and/or postnatal depression). A separation from baby may occur at this time.